Cancer cachexia is an extreme exhaustion that occurs in oncological diseases. It is manifested by a sharp decrease in body weight, muscle weakness, disability, sleep disorders, pallor and flabbiness of the skin, trophic changes in hair and nails, hypotension, decreased immunity, edema, mental disorders, amenorrhea in women and loss of libido in men. Cancer cachexia is accompanied by disorders of all types of metabolism. It often becomes a direct or indirect cause of death of the patient. It is diagnosed on the basis of anamnesis, external examination data and objective studies. Medical treatment.
Meaning
Cancer cachexia is a progressive loss of body weight that occurs with malignant neoplasms and is accompanied by neuromuscular weakness, impaired appetite, disorders of protein, fat, carbohydrate and water-electrolyte metabolism. Cachexia has a pronounced negative effect on the work of all organs and systems. Over time, it becomes the cause of life-incompatible homeostasis disorders. According to various data, it is the cause of death of 20-50% of patients suffering from oncological diseases. It can occur with tumors of any localization, but is more often diagnosed with lesions of the respiratory and digestive systems. Treatment of cancer cachexia is carried out by specialists in the field of oncology, dietetics, gastroenterology, pulmonology and other fields of medicine (depending on the localization of the neoplasm).
Pathogenesis
The pathogenesis of this condition has not yet been sufficiently studied. It is assumed that the main role in the development of cancer cachexia is played by intoxication of the body with the decay products of a malignant neoplasm. Some experts point out that the factor provoking and/or aggravating this syndrome is a secondary infection in the area of a decaying tumor. It has been established that cancer cachexia differs in a number of signs from exhaustion caused by insufficient intake of nutrients into the body. With cachexia caused by fasting, there is a decrease in the amount of adipose tissue. The level of metabolism decreases, the liver atrophies, protein breakdown slows down. With cancer cachexia, the patient loses both fat and muscle tissue. The level of metabolism remains normal or increases, the liver increases, the breakdown of protein becomes more intense.
In addition, cancer cachexia is accompanied by a disorder of all types of metabolism. Disorders of carbohydrate metabolism are manifested by a decrease in glucose levels, a decrease in glycogen stores, an increase in gluconeogenesis and a decrease in insulin sensitivity. Disorders of fat metabolism in cancer cachexia consist in a decrease in the amount of fat, increased lipolysis, decreased lipoprotein lipase activity, increased triglyceride levels and glycerol breakdown. The violation of protein metabolism is indicated by a negative nitrogen balance and increased protein breakdown, including due to striated muscles.
Cancer cachexia occurs against the background of a decrease in the amount of incoming nutrients and an increase in energy costs. A permanent sign of cancer cachexia is an appetite disorder caused by a number of factors, including pain syndrome, taste and olfactory disorders, chemotherapy, radiotherapy and stomatitis, which often develops in cancer patients. Other causes of the development of cancer cachexia are depressive disorder, dysfunction of various organs, nausea, vomiting, growth of tumors of the gastrointestinal tract, compression of the stomach and intestines by neoplasms located in nearby organs.
The increase in energy losses in cancer cachexia is due to the syndrome of impaired absorption and diarrhea, which often occur against the background of radiation therapy, chemotherapy, surgical removal of significant areas of the gastrointestinal tract, pancreatic neoplasms, carcinoid syndrome, thyroid cancer and gastrinoma. Due to significant protein losses, anemia, hypertransferrinemia and hypoalbuminemia occur in patients with cancer cachexia. Trophic skin changes, decreased immunity and limited mobility due to severe weakness cause the development of pressure sores and pneumonia.
Classification
There are three stages of cancer cachexia:
- Precachexia. Accompanied by impaired appetite, decreased glucose tolerance and other signs of exhaustion in the absence of significant weight loss.
- Cancer cachexia. It is diagnosed with a loss of 5 or more percent of body weight in the last six months, with a loss of 2 or more percent of body weight in combination with sarcopenia, or with a decrease in body weight by 2 or more percent if the body mass index is less than 20 kg/m2.
- Refractory cancer cachexia. It is accompanied by a marked deterioration of the patient’s condition, the lack of reaction to chemo and radiotherapy and the ineffectiveness of therapeutic measures to increase body weight.
Symptoms
Patients complain of severe weakness, lethargy, fatigue, fever, constipation or diarrhea. The daily rhythm of sleep-wakefulness is disrupted: at night, patients with cancer cachexia suffer from insomnia, during the daytime they feel drowsy. Women have amenorrhea, men have a lack of libido. Mental disorders develop. Many patients with cancer cachexia suffer from depression. There is tearfulness, irritability and emotional lability, followed by apathy and indifference. With the progression of the underlying disease, disturbances of consciousness are possible.
External examination of patients with cancer cachexia reveals exhaustion of varying severity. Sometimes (as a rule – with tumors of the ovaries, uterus or breast, accompanied by hormonal disorders) patients have normal or increased body weight. The skin of patients with cancer cachexia is dry, flabby, grayish or yellowish in color with an earthy tinge. There is a deepening of wrinkles, a pronounced deficiency of subcutaneous fat, fragility of hair and nails, increased hair loss. There may be protein-free edema, ascites or hydrothorax. Hypotension and tachycardia are determined. Stomatitis develops, loosening and loss of teeth is possible. Anemia is determined by blood tests.
Diagnostics
The diagnosis of “cancer cachexia” is established taking into account anamnesis (the presence of cancer), complaints, external examination data, laboratory and instrumental studies. In the process of diagnosis, attention is focused on a decrease in the amount of food consumed, the predominance of catabolic processes over anabolic, pronounced disorders of skeletal muscle function (decrease in muscle mass, decrease in muscle strength), changes in the functional abilities of the body and deterioration in the quality of life of a patient suffering from cancer cachexia.
To assess the level of anemia, the functional state of the liver and kidneys, a general blood test, a biochemical blood test and a general urine test are performed. If septic complications are suspected, a urine test for bacposev is prescribed. In the absence of a diagnosis of the underlying oncological disease, patients with cancer cachexia are referred for chest x-ray, abdominal ultrasound, colonoscopy, gastroscopy, hysteroscopy, MRI of the brain and other studies (depending on the intended localization of the neoplasm). Appoint consultations of various specialists: therapist, cardiologist, gastroenterologist, neurologist, endocrinologist, urologist, gynecologist, etc.
Treatment
Treatment is symptomatic. Patients with cancer cachexia are prescribed a diet that provides for the use of easily digestible foods with a large amount of proteins, fats, trace elements and vitamins. They use drugs to increase appetite and antiemetics. If necessary (with severe exhaustion, impaired swallowing, severe infectious complications), parenteral administration of glucose, amino acid mixtures, vitamins and electrolyte solutions is carried out. In parallel, therapy of the underlying disease is carried out.
The prognosis in most cases is unfavorable, especially in refractory cancer cachexia. The patients’ condition is gradually deteriorating. Disorders of homeostasis are aggravated due to disruption of the activity of various organs and systems and associated infectious complications. With the loss of 30-50% of protein, a fatal outcome occurs. The immediate cause of death is severe general exhaustion, pneumonia and extensive bedsores. Cancer cachexia kills from 20 to 50% of patients suffering from oncological diseases.